Posts Tagged ‘Fragility Fracture’

Sometimes a person breaks a hip first, then they fall. This happens a lot more often than we realize. When the break is just below the ball of the hip, the fracture may have come before the fall. Moreover, that Fragility Fracture may have gradually developed over days or weeks.

How is it possible that a person does not realize that the hip is gradually crumbling? We call it a Stress Fracture when a crack gradually developes. Small cracks gradually getting bigger are usually not recognized until they are completely across the bone and it breaks, causing the patient to fall. Why?

The aching pain of a stress fracture is often too gradual to distinguish from arthritis pain until the break is complete and the whole bone collapses. The best way to see this process is to watch a video of the I-35W bridge collapsing in Minneapolis on 1st August 2007. http://search.yahoo.com/search?ei=utf-8&fr=aaplw&p=i35w+collapse Tiny cracks slowly developed in the steel until one day……..THUD!

How can you detect who is at high Hip Fracture Risk? A very low DXA T-score, especially in the spine, is a good indication. But DXA often fails if the spine is already crumbling or has arthritis. A better indication is Vertebral Fracture Assessment (VFA). Looking at the spine from the side, Vertebral Compression Deformities can indicate crumbling spongy bone in the spine before the spongy bone in the hip also crumbles.

Recently a patient finished her half hour visit by saying, “so there is nothing you can do for me”. We had discussed Low Bone Mineral Density (BMD) on her DXA; Vertebral Compression Fractures on her VFA; correcting her Diet – Low in Calcium, Vitamin D3 and Protein; Cutting Down her Smoking; back extension Exercises; and possibly Medications that could reverse her Clinical Osteoporosis. None of these interested her.

She was not interested in what she could do to prevent future fractures. She wanted me to “delete” her current Fragility Fracture and the problems she was having from it. She did not believe that she has clinical osteoporosis. She did not believe she is at risk for future fractures. She certainly did not believe that she should be expected to take any action to help herself.

Aunt Henrietta looked like half a raccoon with her entire left eye blackened. She dismissed her looks as not a problem saying, “I fall all the time, but I don’t break anything.” This is a change on both counts. Five years ago, falls were infrequent. Even so, she broke one wrist, then the other wrist, then her shoulder.

Two wrists, one shoulder, and half a dozen vertebral fragility fractures indicated Very Severe Osteoporosis. That was before she took the Anabolic, Forteo, for 2 years. She was the ideal patient for serious measures to stop her fractures. And it has worked!!

A Hip Fracture over age 70 is Very Bad. About 20% of women and over 30% of men die from their hip fracture. Some consider these to be the lucky ones. Nearly half of those who survive a hip fracture spend the rest of their lives in a nursing home.

Many hip fractures should be preventable. There were warnings! Half of the people who break a hip had another Fragility Fracture a few months or years before. Most warnings go unheeded. Hip Fractures that could have been prevented destroy quality of life for too many individuals.